POS0219 COMPARISON OF METHOTREXATE AND AZATHIOPRINE AS THE FIRST STEROID-SPARING IMMUNOSUPPRESSIVE AGENT IN PATIENTS WITH TAKAYASU’S ARTERITIS
Authors: S. Kaymaz Tahra, O. Bayindir, B. Ince, O. Ozdemir Isik, M. E. Kutu, Ö. Karakaş, T. Demirci Yildirim, Z. Ademoğlu, E. Durak Ediboglu, B. C. Uludogan, C. Ilgin, N. S. Yasar Bilge, T. Kaşifoğlu, S. Akar, H. Emmungil, F. Onen, A. Omma, N. A. Kanitez, A. Yazici, A. Cefle, M. Inanc, K. Aksu, G. Keser, H. Direskeneli, F. Alibaz-Oner
Journal: Annals of the Rheumatic Diseases (2023)

Background Conventional disease-modifying anti-rheumatic drugs (cDMARDs) are recommended in addition to glucocorticoids (GC) for all active Takayasu’s arteritis (TAK) patients as the first-line therapy.However, there is limited data comparing cDMARDs as the first-line immunosuppressive (IS) treatment. Objectives In this study, we aimed to compare the outcomes of methotrexate (MTX) and azathioprine (AZA), which were used most frequently as the first-line cDMARDs in TAK patients. Methods TAK patients who received cDMARDs in addition to GCs as the initial therapy were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data of the patients were assessed. In addition, a match analysis (cc match) using variables ‘age’, ‘gender’ and ‘diffuse aortic involvement’ was performed between patients who received MTX or AZA as first-line cDMARD treatment. Results We included 301 (F/M: 260/41, mean age: 42.2±13.3) patients from 10 centres in the study. As the first-line cDMARD, 204 (67.8%) patients received MTX and 77 (25.6%) patients received AZA. First cDMARD was cyclophosphamide in 17 (5.6%), leflunomide in 2 (0.5%) and mycophenolate mofetil in one patient. The remission, relapse and radiographic progression rates were similar between patients who received MTX and AZA as first-line cDMARDs. Vascular surgery rate was higher in the AZA (23% vs. 9%, p=0.001), whereas the frequency of patients receiving ≤5 mg/day GCs at the end of the follow-up was higher in the MTX group (76 vs 62%, p=0.034). Similarly, the rate of vascular surgery was higher and the GC dose reduction rate (≤5 mg) was lower in AZA group in match analysis. Drug survival was similar between MTX and AZA groups (median 48 months, MTX vs AZA: 32% vs 42%, p=0.34). IS therapy was discontinued in 18 (11 MTX, 7 AZA) patients during the follow-up period due to remission. In the IS discontinuation group 2 patients had a relapse at 2 and 6 months, while 16 patients were still on remission at the end of mean 69.4 (±50.9) months of follow-up. Conclusion Remission, relapse, radiographic progression and drug survival rates of azathioprine and methotrexate were similar in Takayasu’s arteritis patients having the first-line of therapy. The rate of vascular surgery was higher and the rate of steroid dose reduction was lower with azathioprine compared to methotrexate at the end of the follow-up. Table 1. Demographic and clinical characteristics of patients with Takayasu’s arteritis Total group (n=301) First-line methotrexate (n=204) First-line azathioprine (n=77) p Age, mean±SD 42,2±13,3 43,5±13,3 40,4±13,2 0,08 Gender, female, n(%) 260 (86) 184 (90) 63 (82) 0,055 Duration of first cDMARD, months 35 (3-336) 35,5 (3-312) 35 (3-336) 0,64 Remission with first cDMARD, n(%) 193/296 (65) 138/199 (69) 50/77 (65) 0,48 Disease activity (baseline ) PGA, active, n (%) 283/297 (95) 191/201 (95) 74/77 (96) 0,70 Kerr, active, n (%) 270/289 (93) 181/195 (93) 70/75 (93) 0,53 ITAS 2010 9 (2-20) 9 (0-19) 10 (3-21) 0,61 Disease activity (12th month) PGA, active, n (%) 53/118 (45) 33/76 (43) 18/39 (46) 0,78 Kerr, active, n (%) 32/120 (27) 24/79 (30) 6/38 (16) 0,26 ITAS 2010 1 (0-11) 1 (0-9) 1 (0-11) 0,48 Relapse rate, n(%) 95/192 (50) 68/138 (49) 24/49 (49) 0,97 Vascular surgery rate with first cDMARD, n(%) 40/291 (14) 17/196 (9) 18/77 (23) 0,001 GC dose reduction (≤5 mg) or discontinuation with first cDMARD, n(%) 153/220 (70) 110/145 (76) 100/65 (62) 0,034 Radiographic progression, n(%) 75/142 (53) 48/98 (49) 22/39 (56) 0,43 CRP, baseline, mg/L 13 (0,4-235) 15,3 (0,5-280) 19,0 (0,4-145) 0,82 CRP, 12th month, mg/L 3 (0,8-130) 4,4 (0,2-200) 3,7(0,4-83) 0,90 Figure 1. Drug survival for methotrexate and azathioprine treatments in TAK patients as first-line cDMARD REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.